Polistena Andrea, Ranalli Monia, Avenia Stefano, Lucchini Roberta, Sanguinetti Alessandro, Galasse Sergio, Rondelli Fabio, Vannucci Jacopo, Patrone Renato, Velotti Nunzio, Conzo Giovanni, Avenia Nicola
Endocrine Surgery, Santa Maria University Hospital, Perugia University, 05100 Terni, Italy.
Department of Surgery Pietro Valdoni, Oncologic and Laparoscopic Surgery, Sapienza University of Rome, University Hospital Policlinico Umberto I, 00161 Rome, Italy.
J Clin Med. 2021 Sep 18;10(18):4246. doi: 10.3390/jcm10184246.
Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention of shoulder syndrome has not yet been defined in comparison to nerve visualization only. We retrospectively analyzed 56 thyroid cancer patients who underwent MRND over a period of six years (2015-2020) in a high-volume institution. Demographic variables, type of surgical procedure, removed lymph nodes and the metastatic node ratio, pathology, adoption of IONM and shoulder functional outcome were investigated. The mean number of lymph nodes removed was 15.61, with a metastatic node ratio of 0.2745. IONM was used in 41.07% of patients, with a prevalence of 68% in the period 2017-2020. IONM adoption showed an effect on post-operative shoulder function. There were no effects in 89.29% of cases, and temporary and permanent effects in 8.93% and 1.79%, respectively. Confidence intervals and two-sample tests for equality of proportions were used when applicable. Expertise in high-volume centres and IONM during MRND seem to be correlated with a reduced prevalence of accessory nerve lesions and limited functional impairments. These results need to be confirmed by larger prospective randomized controlled trials.
侧颈清扫术（LND）会导致包括副神经损伤在内的显著发病率。改良根治性颈清扫术（MRND）旨在保留副神经，但患者术后功能结果往往不佳。与仅通过神经可视化相比，神经监测（IONM）在预防肩部综合征中的作用尚未明确。我们回顾性分析了一家大型机构在六年（2015 - 2020年）期间接受MRND的56例甲状腺癌患者。研究了人口统计学变量、手术方式、切除的淋巴结及转移淋巴结比例、病理、IONM的应用情况以及肩部功能结果。平均切除淋巴结数为15.61个，转移淋巴结比例为0.2745。41.07%的患者使用了IONM，在2017 - 2020年期间使用率为68%。IONM的应用对术后肩部功能有影响。89.29%的病例无影响，分别有8.93%和1.79%的病例有暂时和永久性影响。适用时使用了置信区间和比例相等的双样本检验。大型中心的专业技术以及MRND期间的IONM似乎与副神经损伤发生率降低和功能障碍受限相关。这些结果需要通过更大规模的前瞻性随机对照试验来证实。
